冠状动脉旁路移植术后机械通气时间延长的危险因素分析

Predictive risk factors of prolonged mechanical ventilation following coronary artery bypass grafting

目的分析影响冠状动脉旁路移植(coronary artery bypass grafting,CABG)术后撤离呼吸机的术前及术中危险因素。方法对703例连续CABG患者进行回顾性研究,分为24h内拔管组(组Ⅰ)与24h内未拔管组(组Ⅱ)。利用单因素及多因素分析,筛选机械通气时间延长的危险因素。结果单因素分析表明,术后延长机械通气时间与年龄(P=0.006)、左室射血分数(P﹤0.001)、术前心功能(P=0.009)、是否术前3个月内有心肌梗死(P﹤0.001)、是否急诊手术(P﹤0.001),术前、术中、术后是否应用主动脉球囊反搏(IABP)(P﹤0.001,P=0.001,P﹤0.001)有关。Logistic回归分析表明,术前肌酐水平增加(P=0.044)、女性(P=0.003)、左室射血分数下降(P=0.018),术前、术中、术后应用IABP(P﹤0.001,P=0.010,P﹤0.001)是术后延长机械通气的预测因子。结论性别、心肾功能及围术期应用IABP是影响CABG术后撤离呼吸机的危险因素。

Objective To analyze the predictive risk factors affecting extubation of mechanical ventilation after CABG. Methods 703 consecutive patients undergoing coronary artery bypass grafting from Oct 2003 to Dec 2005 were analyzed retrospectively. Patients were divided into group Ⅰ（extubate within 24h） and group Ⅱ（failed extubation within 24h）. 28 preoperative and intraoperative factors that may affect extubation were recorded.Univariate and multivariate anal- yses were performed using logistic regression to find out related risk factors. Results Univariate analyses showed that there was significant difference between group Ⅰ and group Ⅱ in age [（63.8±9.2）years vs （66.7±8.9）years, P=0.006], LVEF （60.4%±11.9% vs 54.1%±15.3%, P 〈 0.001）, NYHA classes （P=0.009）, acute myocardial infarction within three months pre-operatively（114/622 vs 38/81, P 〈 0.001）, emergency operation（68/622 vs 25/81, P 〈 0.001） and uses of IABP in preoperation, intraoperation, or postoperation（9/622 vs 13/811 P 〈 0.001; 26/622 vs 12/81, P=0.010; 4/622 vs 11/81, P 〈 0.001）. Logistic regression analyses revealed that preoperative increasing of Cr level （OR=1.012, P=0.044）, female （OR= 2.818, P=0.003）, LVEF（OR=0.970, P=0.018）, uses of IABP during pre-, intra- or post- operation（OR=14.782, P 〈 0.001 ; OR=3.831, P=0.010; OR=36.127, P 〈 0.001） were independent predictors of prolonged mechanical ventilation. Conclusions Female, poor cardiac function or renal function and emergent operation have effect on extubatian of mechanical ventilation.